1.If infertility is suspected to be caused by poor semen quality, what tests should be done at the consultation?
There are many reasons for the decrease in semen quality and great individual differences. It is recommended to go to the hospital for specialist consultation and try to clarify the cause according to your own situation, common tests include.
(1) Semen analysis: It can show whether the sperm density is normal. If the number of sperm of class a is 25%, the number of sperm of class (a+b) is 50%, and the sperm viability is less than 60%, then it can be diagnosed as weak spermatozoa. If the sperm density is less than 20 million, it can be considered as idiopathic oligospermia if the abstinence is 3-7 days and the semen is routinely analyzed for more than 3 times. Gu Zhaohui, Department of Urology, First Affiliated Hospital of Zhengzhou University
(2) Seminal plasma biochemical examination: It mainly includes the determination of seminal plasma fructose, glucosidase, acid phosphatase, etc. Patients with weak spermatozoa will generally have abnormalities in the examination of these indicators. The presence of inflammation of the reproductive system can be confirmed based on the presence of frequent urination, urinary urgency, painful urination, as well as purulent discharge from the external urethra and increased pus cells in urine examination.
(3) Immunological examination: This includes routine examination of seminal plasma and serum for anti-sperm antibodies and anti-Toxoplasma gondii antibodies. Immunological tests can determine if there is an autoimmune problem, and karyotype analysis can determine if there is a chromosomal abnormality. Measurement of serum is also an important method to check for oligospermia. If FSH and LH are below normal, it is secondary oligospermia, and elevated PRL is oligospermia caused by hyperprolactinemia.
(4) Prostate examination: mainly to see the color and shape of the prostate and lecithin vesicles in infertile patients, normal semen mainly appears grayish white with viscosity. The chronic prostatitis as well as mycoplasma and chlamydia infections are also important causes of weak spermatozoa, and if necessary, patients should also do routine examination of prostate fluid, etc.
(5) Ultrasound examination: Ultrasound examination can be used to find out whether men have varicocele, vesiculitis, epididymitis or prostatitis and other diseases.
(6) Endocrine examination: The function of hypothalamic-pituitary-testicular axis can be understood through stimulation test, and the measurement of testosterone level can directly reflect the function of interstitial cells, and thyroid hormone, adrenocorticotropic hormone or lactogen can be measured if necessary.
(7) Routine semen examination: It helps to understand male fertility and is a mandatory test for infertility. The examination includes color, volume, liquefaction time, acidity, sperm count, motility, survival rate and morphology.
(8) Testicular biopsy: used for azoospermia or oligospermia, to directly examine the spermatogenic function of testicular varicose ducts and the development of interstitial cells, and the synthesis and metabolism of local hormones can be reflected by immunohistochemical staining.
(9) X-ray examination: To determine the obstruction site of the vas deferens, vas deferens, epididymography, vas deferens, seminal vesiculography or urethrography, etc. In hyperprolactinemia, X-ray tomography (frontal and lateral) of the pterygoid saddle is taken to determine the presence of pituitary adenoma.
2.How many times does semen examination need to be done, and how much time between each examination? What is the effect of too long or too short a time?
If the semen analysis is normal according to WHO standards, then once is sufficient. If there are two abnormal semen analyses, further male examinations are required. The interval is about 3 months. Too long a time affects the treatment of oligozoospermia. The semen production cycle takes nearly 3 months or so, and if the time is too short, the results of two examinations are not very meaningful.
3. Can the diagnosis of oligozoospermia be confirmed if the semen test results are good and bad?
The definition of oligozoospermia is to analyze the results of a single semen examination. If the semen retrieval process meets the specifications, the diagnosis of oligozoospermia or oligozoospermia can be made for this semen quality, and if necessary, it can be re-examined after 3 months.
4.What are the precautions before semen examination?
(1) The length of abstinence will affect the parameters of semen analysis. Therefore, semen should be taken during 48 hours to 7 days of abstinence; (2) No condom, lubricant or saliva should be used during semen extraction, and semen specimens should not be contaminated by urine, water, soap, etc. (3) Semen samples should preferably be obtained in a separate room near the laboratory, otherwise they should be sent to the laboratory as soon as possible (within 1 hour after sperm retrieval). If part of the ejaculated semen is lost, the specimen will not reflect the true condition of the patient’s semen. The semen sample is well insulated (20~400C) during transportation. (4) If semen microbiological examination is to be done, urinate and wash the penis and hands beforehand, and especially flip the foreskin for washing if the foreskin is too long. Those with adherent foreskin or circumcision must first deal with these problems before masturbating to collect semen.
5, after the diagnosis of less weak spermatozoa generally need to do what tests to clarify the cause?
After the diagnosis of oligozoospermia is confirmed, we need to perform specialist examinations to clarify the main causes of oligozoospermia as far as possible, and the general examinations include.
(1) Hormone level examination: Infertile patients are more likely to have endocrine abnormalities than ordinary people, but these patients are relatively rare. When there are abnormal semen indicators, the hormone tests we need to perform are limited to the detection of only three hormone levels: follicle stimulating hormone (FSH), luteinizing hormone (LH) and testosterone (T). It is essential to identify whether the azoospermia or extreme OAT syndrome is caused by obstructive or non-obstructive factors. A reasonable predictive value reflecting obstruction is a normal FSH with normal bilateral testicular volume, otherwise indicating a non-obstructive factor; however, there are still approximately 29% of men with normal FSH levels who have impaired spermatogenesis, i.e., a non-obstructive factor is present. In patients with unexplained hypogonadotropic hypogonadism, further investigations should also include MRI/CT of the pituitary gland.
(2) Microbiological examination: Indications for microbiological evaluation are a combination of: urinary abnormalities, urinary tract infections, male accessory gonadal infections and sexually transmitted diseases. Although the clinical significance of leukocytes inside the semen specimen is still uncertain. However, in combination with low ejaculate volume, the possible cause is incomplete obstruction of the ejaculatory ducts due to chronic inflammation of the prostate or seminal vesicles. Reproductive tract infections can cause the production of oxygen radicals with sperm toxicity. Gonococci and Chlamydia trachomatis can also cause obstruction of the genital tract. Although antibiotic treatment of male accessory gonadal infections can improve sperm quality, it does not necessarily improve pregnancy rates.
(3) Genetic evaluation: A significant number of male fertility abnormalities, previously often dismissed as idiopathic male infertility, in fact have a genetic origin. Many of these patients can be detected by taking an extensive family history and performing karyotyping, which allows not only for diagnosis but also for appropriate genetic counseling, especially in the latter case. With the advent of ICSI (intracytoplasmic sperm injection), genetic testing and counseling have become important because fertility abnormalities and possibly associated genetic defects can be passed on to offspring.
(4) Ultrasound: Ultrasound has become the primary screening tool for detecting lesions in the scrotum. Ultrasound Doppler examination of the scrotum can detect varicocele in 30% of infertile patients. 0.5% of infertile patients have testicular tumors, and 2-5% of infertile patients, especially those with a combined history of cryptorchidism, have testicular microcalcifications (potential precancerous lesions). Transrectal ultrasonography can exclude those infertile patients with low ejaculate volume (<1.5 ml) due to midline prostatic cysts or ejaculatory duct obstruction caused by ejaculatory duct stenosis.
(5) Testicular biopsy: The indications for diagnostic testicular biopsy are patients with azoospermia or extreme oligospermia syndrome with normal testicular volume and serum FSH levels. The purpose of the biopsy is to distinguish between testicular insufficiency and male genital tract obstruction. Testicular biopsy in patients with non-obstructive azoospermia is intended to be performed as a therapeutic tool, only when sperm are obtained by ICSI. Testicular tissue obtained by testicular biopsy containing sufficient sperm should be frozen and preserved for ICSI.
(6) Others: Some lifestyle habits may also lead to decreased semen quality, such as: smoking, alcohol abuse, application of metabolic steroids, excessive exercise (endurance training, excessive strength training), wearing insulated underwear resulting in high temperatures in the scrotum, sauna or hot tub use or engaging in occupations with high heat exposure, and taking medications that affect sperm quality. Changes and adjustments can be made under the guidance of a doctor to improve semen quality.
6.How long do I need to wait for an appointment for each of these tests? How long does it take to get the results after the examination
General tests include: ultrasound, hormone levels, microbiological tests, testicular biopsy, cytogenetic tests, etc. The ultrasound test may take a few minutes to a day, depending on the time of the visit and the number of ultrasound examinations, and the results may be available immediately or a few minutes after the test. Testicular biopsy can generally be performed on the same day, and the biopsy results need 2-3 days to get the results; cytogenetic examination requires human peripheral chromosome preparation, chromosome G-banding technology processing, reading and analyzing the etiology of the disease, etc., which generally takes a week to several weeks, and the specific details should be asked to the laboratory physician.
7.How long does it take for patients with drug treatment to have a follow-up visit and what tests should be done?
First of all, the cause of oligozoospermia should be clarified.
(1) If it is inflammation caused by less weak spermatozoa drug treatment, usually 1-2 courses of treatment after a review, review items vary according to the cause, common prostate fluid, semen smear examination, bacterial culture, etc..
(2) If it is a drug treatment for abnormal hormone metabolism or primary oligospermia, it varies from person to person and from drug to drug, so you should ask your doctor about the precautions to take during medication and the interval between reviews.
(3) It takes about 3 months to know the improvement of semen quality after medication. The human spermatogenesis cycle is 16 days, and the process of spermatogenesis takes about 4 cycles, so it generally takes 64 days for human spermatogenesis.
The maturation of spermatozoa in the epididymis, the acquisition of the ability to move forward, the ability to adhere to the zona pellucida and the ability to fertilize takes about 12 days. Therefore, it takes more than 76 days for spermatogenesis to mature, and the review of semen quality usually takes about 3 months.